Ergonomics of In-Office Nasolaryngoscopy: Comparison Between Conventional and Pistol Grip Techniques

In-office nasolaryngoscopy in otolaryngology is a short but frequently performed procedure that can lead to substantial ergonomic risk. This study seeks to compare the ergonomic difference between pistol and conventional grip techniques during in-office nasolaryngoscopy.

Twelve otolaryngology staff, residents, and speech language pathologists were prospectively enrolled. Each practitioner was observed performing nasolaryngoscopy on 20 to 40 patients using either the conventional or pistol grips. Ergonomic assessments were conducted using the Rapid Upper Limb Assessment (RULA) Employee Assessment Worksheet. Descriptive statistics were used to summarize practitioner characteristics, raw RULA scores, and RULA risk categories. Linear mixed models with random intercepts were used to compare the raw RULA scores of the two grips.

Of the total 403 procedures observed, 211 were performed using the conventional grip and 192 using the pistol grip. According to RULA risk categorization, 77.08% of the pistol grip procedures were classified as low ergonomic risk, compared to 58.29% for the conventional grip. Mean RULA scores were 4.1 ± 1.3 for the pistol grip and 4.7 ± 1.3 for the conventional grip. There was a significant mean difference of 0.65 (95% CI: 0.48, 0.82; p < 0.0001) between the two groups.

Overall, both the pistol grip and conventional grip techniques fell into the same RULA ergonomic risk category. However, the pistol grip had a significantly lower average final RULA score than the conventional grip. Further studies are needed to evaluate the feasibility and broader adoption of the pistol grip across various otolaryngology endoscopic procedures.